Why Do People Complain?

Natalie Bradley studied at Newcastle Dental School and qualified in June 2014. "I wrote this article based on a talk by Jane Merivale who talked at the FGDP Open Day" "it is an explanation of how complaints come about and how to manage them in practice."

I have realised in the few months that I have been practising out in the big wide world that dentistry isn't just about clinical skill: people skills and effective communication are key when treating patients.

Dentistry is unique as a health profession, not only should you provide excellent health care to your patients, but it is also a business and in some ways your patients are actually your customers. Therefore it is vital that your patients are satisfied with your care and the service they receive.

Often, complaints arise as a result of a misunderstanding or as a result of poor communication, and it is hard not to take a complaint to heart. Whilst nobody likes receiving a complaint, it is important to respond to it constructively and professionally to improve the care we provide.

Satisfaction and Dissatisfaction

As consumers, things that we buy tend to be either products or services. Sometimes in dentistry, the care we provide is an overlap of both these things such as the provision of a denture or crown.

There is a spectrum of dissatisfaction ranging from those you are satisfied enough to present you with a gift, to those who are dissatisfied enough to complain or sue. The majority of patients fall into being either 'silently satisfied' or 'silently dissatisfied'.

The problem with this is that we don't receive feedback on how well we are doing as dentists and those who are silently dissatisfied disappear off the radar and go see someone else. This is the reason why we should welcome complaints so we can reflect on how well we are doing in order to improve our skills.

Why do some people complain and others don't?

Many different factors influence whether a person complains. These can include:

The person's personality and assertiveness

If the patient is busy as it takes time and effort to complain

If it is easy for them to complain and whether they are obstacles in their way

If they have the view that it won't make a difference

Some people prefer to tell people they know rather than complain

It can depend on what went wrong and what factors are at work

Happy, satisfied and appreciative patients are less likely to complain and are less likely to sue, even when mistakes occur!

What people are looking for when they complain?

OUTLET - letting off steam, feeling respected and being taken seriously

APOLOGY - this doesn't have to be an admission of fault. You can say sorry in different ways as long as it is sincere

EXPLANATION - but only if this is what the patient wants. Lots of explanations may sound like excuses!

REMEDY - only the patient knows what will put things right in their eyes, so ask!

REDRESS - compensation does not always have to be monetary

RETRIBUTION - settling the scores

What makes some people want to take things further?

The best place to resolve issues is in practice but some patients, less than 3%, want to escalate things either to the GDC or to submit a negligence claim with their lawyers.

This could depend on:

● How much they like you

● Whether they think you like them

● Whether or not they think you care about them

● Whether they trust you

● How important or valued you make them feel

If you are unwilling to listen, appear rushed, are disinterested or lack concern you are more likely to be sued.

Danger signs

According to a study by Dental Protection there are 6 danger factors that either alone or in combination seemed to be the strongest drivers behind a complaint:

Pain

Money – "why should I pay, it's all your fault!"

A sense of violation - 'I trusted you and you let me down'

Interpersonal problems - falling out of some sort

Dignity - dentist perceived to be arrogant or dismissive

Consequences - 'I had a wedding to attend'

Ingredients of an effective in-house complaints system

Organisational culture and leadership

Issues should be addressed and problems sorted out before other parties become involved e.g. lawyers, GDC, Health Ombudsman, Dental Complaint Service.

We can learn valuable lessons from complaints and identify problems in our practice. Ultimately we can rebuild stronger relationships with our patients.

Management, systems and processes

Complaints need to be well designed and operated by the right people with the correct skills although this doesn't necessarily mean the most senior person in the practice.

The system needs to be accessible, fair, simple, non-threatening, confidential, speedy, flexible and promote improvement.

Top Tips for Complaints Handlers

Keep your cool- Stay calm and professional, demonstrate your concern, give the patient choices and follow up after a resolution has been achieved.

Use the 'Sad but Glad' technique- e.g. I am sorry you are unhappy but I am glad that you told me.

Don't be afraid to ask what you can do to put things right!

The sooner you find this out, the sooner you can resolve the situation. Even if you don't think you can give them what they want, you can at least start thinking about what you can offer them in order to move towards a solution.

DO NOT:

Blame the patient - this will escalate the patient's dissatisfaction

Pick a fight - resolving a complaint is not the same as winning an argument

Ignore complaints - they will not go away and patients will view this as a sign of disrespect

Litigation is exceptionally high in this country so it is essential to have an effective in-house complaints procedure and make sure that patients are aware of them. It is a GDC standard to make sure patients have a clear way to complain. If patients are unaware your complaints procedure, the next thing they'll do is turn to Google and the GDC - something we would all like to steer clear of!